Obama Take 2: Tobacco, Obesity Key in Second Term

by David Pittman David Pittman,Washington Correspondent, MedPage Today
January 20, 2013

WASHINGTON -- The second term of an Obama administration will be marked for implementing key provisions of the Affordable Care Act (ACA), but the president also wants to focus on lowering tobacco use and obesity rates, a senior administration official said.

Obama and the Department of Health and Human Services (HHS) plan to release a number of new initiatives in these areas while continuing already launched programs, according to Howard Koh, MD, MPH, HHS assistant secretary for health.

"In the second term, we're eager to reaffirm and re-energize our commitment to the public health," Koh told MedPage Today in an interview Friday.

One in three adults is considered obese, along with one in five children, said Koh, who serves as the senior health adviser to HHS Secretary Kathleen Sebelius. Meanwhile, tobacco kills 1,200 people a day and each deceased smoker is replaced by two new youth smokers.

"These are the most challenging public health issues of our time," Koh said.

The FDA will launch a media effort later this year aimed at preventing childhood tobacco use. It should complement a similar effort already underway by the CDC.

"The general public and healthcare providers will be hearing much more on the importance of tobacco cessation or prevention in the upcoming term than we've heard in quite a while," Koh said.

In the area of obesity, HHS later this year will review physical activity guidelines, which were first launched in 2008, to see where interventions could be successful, Koh said. The White House also will expand the efforts of First Lady Michelle Obama's Let's Move! campaign, her childhood obesity intervention.

The Healthy People 2020 initiative, which monitors national health trends and sets public health goals, aims to reduce adult and childhood obesity by 10% each before the end of the decade.

HHS set a goal of trying to reduce adult smoking rates to 12% by 2020. Currently, that rate is close to 19%, Koh said.

"For obesity, we're simply trying to get the trends to move in a positive direction because over time they've gone in the wrong direction," he added. "We're seeing some signs of youth obesity trends plateauing and maybe declining in some cities ... So that's encouraging, and we want to build on that for the future."

Tobacco prevention and efforts to lower obesity rates were already the focus of several efforts during Obama's first 4 years in the White House.

Koh's office released new dietary guidelines in 2010, as well as the country's first physical activity guidelines.

Also, the ACA furthers the promotion of smoking cessation and prevention through health plans. For example, smoking cessation is considered a preventive service under the law.

The FDA tried to use its newly granted powers under a 2009 law giving them authority to regulate tobacco to slap graphic warning labels on cigarette packages. That effort was shot down by multiple courts last year, citing cigarette companies' First Amendment rights.

HHS is trying to reach broader audiences by taking its message beyond a doctor's office -- the place where people traditionally think they turn for health information.

"We now know that in the 21st century ... health begins where people live, labor, learn, and play," Koh said.

He hopes cash-strapped states and school districts realize the importance of some of their efforts -- particularly in the area of childhood obesity -- in helping the country improve its health.

"We view investing in prevention as an outstanding investment," Koh said. "We have to take action now to prevent future costs."